Provider Demographics
NPI:1700169711
Name:SHORTSLEEVE, ELIZABETH BLACK (NP-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BLACK
Last Name:SHORTSLEEVE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 KILVERT ST
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1379
Mailing Address - Country:US
Mailing Address - Phone:401-258-2551
Mailing Address - Fax:855-643-5020
Practice Address - Street 1:279 NORTH ST
Practice Address - Street 2:
Practice Address - City:MEDFIELD
Practice Address - State:MA
Practice Address - Zip Code:02052-1211
Practice Address - Country:US
Practice Address - Phone:401-258-2551
Practice Address - Fax:855-643-5020
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP37637363LF0000X
MARN2264330363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily